PBL extra LOs

Question 1

if diplopia remains when one eye is closed, what is the likely cause of it

Answer 1

refractive error

Question 2

what is latent diplopia

Answer 2

where there is a subconscious effort to keep the eyes aligned and so diplopia only manifests when there is a lapse in effort (e.g. when tired) causing control to be lost and deviation to occur

Question 3

concomitant vs incomitant squints

Answer 3

concomitant - deviation of the eyes remains constant with changes in the angle of gaze (i.e. moves with the other eye except in the direction that there is a defecit);
incomitant - there is a change in the angle of deviation in different positions of gaze, or according to which eye is used for fixation (i.e. the eye remains in a fixed position when the other moves)

Question 4

what are 3 common causes of incomitant squints

Answer 4

neurological, mechanical or myogenic problems affecting the muscles controlling eye movements

Question 5

CNIII Palsy presentation

Answer 5

dropping eyelid with the eye in a down and out position; pupil may also be dilated (if this is the case send for emergency scan as could have brainstem aneurysm)

Question 6

Normal pressure hydrocephalus presentation (3)

Answer 6

1. Dementia
2. Incontenance
3. Abnormal gait

Question 7

what is lateral medullary syndrome

Answer 7

vascular event causing damage to the medulla oblongata

pica can’t chew -> Postierior inferior cerebellar aterty (and dysphagia is a symptom)

Question 8

lateral medullary syndrome presentation

Answer 8

1. Impairment of pain and thermal sensation over the contralateral side of the trunk and limbs;
2. Impairment of pain and thermal sensation over the ipsilateral face
3. Ipsilateral Horner syndrome
4. Ipsilateral limb ataxia
5. Dysphagia
6. past pointing worse ipsilaterally

Question 9

what do absent ankle jerks, brisk knee reflexes and gait abnormalities indicate

Answer 9

myelopathy - mixed upper and lower motor neuron signs e.g. MND, freidrich’s ataxia

Question 10

what is a complication of ocular surgery

Answer 10

endophthalmitis - infection of the aqueous and vitreous humour -> painful, red eye, vision loss, acute onset, hypopyon

Question 11

what is a possible side effect of carbamazepine

Answer 11

steven johnson syndrome

Question 12

what drug classes affect the liver (2)

Answer 12

1. anticonvulsants
2. anti TB

Question 13

what drug classes affect the kidney (2)

Answer 13

1. aminoglycosides
2. diuretics & other HF drugs

Question 14

what is a serious side effect of bisphosphonates

Answer 14

jaw osteonecrosis

Question 15

what is a serious side effect of metformin

Answer 15

lactic acidosis

Question 16

what is a serious side effect of carbimazole/clozapine

Answer 16

bone marrow suppression

Question 17

what is a serious side effect of statins

Answer 17

myositis

Question 18

what phase of the pacemaker cycle does amiodarone act on

Answer 18

phase 3 - main repolarisation

Question 19

what abx does methotrexate react with

Answer 19

trimethoprim -> leads to myelosuppression, mucositis, and nephrotoxicity

Question 20

what approach should be used when predicting/preventing adverse drug reactions

Answer 20

DoTS
D - dose relatedness (what dose does ARD happen)
o
T - time relatedness (when does it happen)
S - susceptibility factors